Developing

concentration
skills in
primary age
children.
(Treating ADHD/ADD without
medication?)

Tim Francis Educational Psychologist

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 Copyright
This package is copyright free and photocopy free. Should you wish you
can download and print further copies from:

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to do so, provided there is a link back to us, or a reference to the web site.

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 Contents

1. Background
2. Purpose of the program
3. Who would benefit?
4. The costs and benefits.
5. A general overview of the course.
6. How to run the program
7. The Group Sessions
8. How to run the games

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 Background.

There is a long history of children finding concentration difficult due to

having a restless nature. There is a history within medicine going back to
the 1930’s and beyond of these children responding to stimulants. To the
uninitiated the thought of a very active child being given stimulants to calm
them down is counter intuitive to say the least. That is until the underlying
theory has been explained.

In essence the theory is that the child with ADD/ADHD will have an under
active cortex (the very thin lining covering the brain). The child therefore
seeks to arouse their cortex due to the psychological discomfort they feel.
The children probably arouse their cortex in a number of ways, some of
which we notice more than others. A parent or teacher would not notice or
worry about a child shaking their leg or enjoying the movement of a piece of
cotton being moved by a fan. They would notice if the child hit the child
next to them. The resultant telling off is of course very arousing, and can I
believe become partially addictive, resulting in teachers and parents
complaining that the child seems to enjoy being told off. It can, I would
suggest also offer the child a very cheap and easy way of finding arousal.
Leading to a negative pattern of behavioral interaction between child and
those who care for them. Fortunately this knowledge also leads us to a very
effective intervention plan.

From a medical point of view there is a physiological deficit and this can be
addressed by adjusting the physiology of the patient. Hence stimulants are
given that act directly upon the cortex. A chemically aroused cortex results
in a child who is not experiencing psychological discomfort. As they are not
in need of arousal they do not engage in actions designed to arouse. They no
longer irritate their peers, teachers and parents or shake their leg. Well, not
so much, anyway. Of course as they have spent so long living outside the
normal behavioral patterns for their cohort they will often lack appropriate
social skills. They will in all probability lack concentration skills because
this is a skill that develops by doing it, and they haven’t been. This is why
the recommended approach by medical practitioners in this area would
usually include some form of social skills training in conjunction with
prescribed medication.
(See www.educational-psychologist.co.uk/social.htm for an example of such
a training programme.

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Should the reader wish to engage in some personal research they will find no
end of positive testimony with respect to the miraculous effects of stimulants
on children when accurately diagnosed as ADD/ADHD. From the
viewpoint of the child suddenly they are out of the most awful mess. No
child wants to be at loggerheads with their parents and teachers. The
medication if effective comes as a blessed relief to all involved, but mostly
to the child. It is cheap and relatively quick to take effect. It conforms to
the thinking of modern western society, in that respect. At this point it must
be clarified that this Educational Psychologist is not anti the
physiological/medical approach. Having found and referred many children
who subsequently were medicated with miraculous results it would be
hypocritical to suggest otherwise. However, this does not mean that there is
not an alternative approach that may work, in a good proportion of cases.

The problem with a non-medicated approach is that it requires lots of time

from skilled people. It is not as effective as medication with respect to the
speed of effect. A non-medicated approach is very expensive for something
that is not as good in terms of strike rate. The benefits are that some
children will learn to manage themselves without medication and the side
effects, which the reader can research very easily on the Internet or in a good
library, don’t come into the equation. As the non-medicated approach is
simply an extension of the concentration skills and social skills programme
that the child will need if the medicated approach is to be run according to
medical advice. It seems to this writer that it would be useful to start from
the non medicated intervention and only use medication if the difficulty
proves to be persistent.

So, in an ideal world, children with concentration difficulties and a restless

nature would be detected early in their school life by their teachers. They
would be given the chance to attend some withdrawal sessions that would
consist of small groups of similar aged children. These children would learn
how to concentrate and keep themselves on task. Their internal strengths
and skills would be enhanced, as would the array of strategies available to
them with respect to on task behaviors. They would also be supported in
the development of their social skills and relationship skills to make up for
the skills they have missed due to being outside the group due to their
behavior.

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If this sounds like sensible and logical thinking then read on because this
approach does work but it requires tenacity on the part of the group leader,
patience on behalf of the school, particularly the class teacher. It will not be
effective in every case. If this approach is not effective then this writer has
no hesitation whatsoever in suggesting that the reader explores the
medical/physiological approach. The worst avenue to take is to leave the
child with no effective support. It is our duty as adults to find something
that works and use it. This manual suggests a conservative approach first. It
does not suggest inaction on behalf of adults with responsibilities for the
child if the non-medicated approach is not working.

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 Purpose of the programme:

• To provide a user-friendly basic programme that can be run by a class

teacher or primary helper.

• To act as part as a code of practice stage two individual education plan.

• To be diagnostic in the context of the code of practice, to assist in

identifying children who may need to proceed to stage three.

• To allow the children who participate in the group the opportunity to

develop specific skills with respect to concentration and staying on task
in a school classroom.

• To provide a caring environment for children to learn by experiment,

experience and practice.

• To allow the children to have their developing skills acknowledged and

rewarded.

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 A General Guide to Running Groups.

The following is a step-by-step guide to starting and running a group:

1. Time:
• Establish a consistent time and day the group is to meet and stick to this.

2. Place, you will need to find a room that:

• You and your group have sole use of during your time together.
• You will not be interrupted, over looked or overheard.
• You can have every week during the programme of the programme.

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3. Membership:
• If the groups are run effectively you will find that most of the children
will want to come and take part as they are getting attention they may not
be getting elsewhere. You may have to make a decision as to whether
attendance will be optional or compulsory in the first instance.

• Choice of group size is up to you, but from our experience groups of

between six and twelve are the most effective size overall. Do not
hesitate to reduce the group size down to two if you feel that the needs of
the children can be met that way.

4. Rules:
• You may choose to have no rules but we have found that to have some
rules helps the children to feel safe and sets clear limits.

• You may choose to set rules that are important to you and ask the
children if they would like to add to these, rules can be added at any point
in the life of the group.

• These are the rules we have used:

1. Confidentiality within the group of what's discussed within the group.
Discuss this with reference to when you as group leader may have to
break that confidentiality.
2. Only one person to talk at any one time.
3. No eating or drinking.
4. Treat one and another with respect.

You will certainly need to teach the children what you mean by the above
rules.

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 Who Would Benefit?

If a child has been diagnosed as having ADD/ADHD by a professional

recognized as being competent to undertake such a diagnosis. Then you
would be well advised to follow the recommendations of that professional.
This manual is designed for teachers and perhaps parents or other adults who
have a child that is more restless than his/her peers. They may also have
weaker social skills and as such be in more conflict with peers than the
average child in their group. This will be a matter of professional judgment.
Boys are often more inclined to run around than girls. Some girls like to run
around and be lively and so stand out, just as some boys like to sit and talk
and do not like to run about. This doesn’t mean that there is a problem.
There is a range of behaviors that your culture recognizes as appropriate.
This manual is designed to help teach skills to a very small group of children
who are restless to the point that it is having a serious effect on their learning
and social relationships. Their behavior will be very much outside the
cultural norms of the society and culture you are living in.

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 The Costs and Benefits

By engaging in this programme the parent and teacher are recognizing that
the child has special educational needs at some level. The parents should
be informed, they are welcome to a copy of this manual, for which they
should only pay for the photocopying costs, if required by school. As the
work takes place as part of a withdrawal group the child must necessarily be
removed from class for several short periods of time each week. In some
schools, children go in and out of the classroom regularly for various things.
This is not seen as anything unusual or negative in this type of context. As
the children usually enjoy group work and come back with tales of what fun
they have had, the only negative effect is the curriculum time lost. If your
school is not one where children leave the class regularly of if they do, they
are see as being a “Div” or some other derogatory connotation. Then the
decision becomes much harder and the cost benefit analysis less favorable to
the cognitive/behavioral approach and perhaps gives more favor to the
medical/physiological approach. It is a very tough call but one that is
present in much of SEN work.

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 A General Overview of the Course

The underlying philosophy behind this course is not to treat ADHD/ADD

but to recognize as a professional that a child has a difficulty in a specific
area of development. Put behaviorally they spend less time sitting still with
their pencil moving when given a pencil and paper task than the vast
majority of their peers. More generally they may be described as having a
problem with concentration. Most if not all children have difficulties with
some things and have lots of strengths. Some may find riding a bike easy
but reading difficult for example. Within all cultures there are acceptable
difficulties and non-acceptable difficulties. For instance finding bike-riding
skills difficult is not seen as a big problem in the UK. Someone will
probably take the child to the park and let them fall off a few time onto the
soft grass. With a lot of encouragement and a little advice the child will ride
their bike even if it is with less skill than many of his/her peers. Likewise a
problem learning to read is acceptable. We know that this gets treated much
more seriously than bike riding (sometimes with the consequent emotional
loading). Nevertheless the child is given extra help ranging from a bit of
extra help from the teacher in class to inclusion in full-blown support
schemes such as Reading Recovery and of course most children do manage
to read eventually.

Having a problem with things that are normally learnt less overtly often
causes confusion. Thus having a difficulty with friendship making, listening
skills or concentration for instance may result in the application of sanctions
rather than the application of teaching. All this course is advocating is that
you give teaching a go, in the same systematic and professional way that you
teach other things.

The course of action detailed in the remainder of this manual details how a
child may be taken from very poor concentration in pencil and paper
activities to having observably better concentration skills in paper and pencil
activities. This is measured by time on task. On task is determined by the
observable behaviors of:

• Bottom on seat
• Head down
• Pencil moving.

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The children are taken through a series of activities from simple coloring
tasks to engaging in set tasks given by the teacher. They are supported by
inclusion in a small group where they can have lots of teacher and peer
praise and monitoring. They are also supported by the fact that the group
has total up front face validity. They are told why they are there, poor
concentration, and the tasks all link to the development of that skill. The
class teacher and parent all know that the child is working toward a specific
skill and will naturally praise and reward as they see the child practice
his/her new skills in this specific area. The intervention has a two-pronged
approach firstly to develop on task skills. The inner voice that tells us to get
back down to it. Secondly the development of the inner strength and
resilience that keeps us on task when there are other much more interesting
things that we could be doing, such as playing with that new box of Lego
next to the teachers desk.

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 How to Run the Program

Firstly you will need to establish the focus of your group. Are you going to
focus on social skills and concentration development or are you going to
keep it simple and just focus on concentration. If you are new to group work
the best advice would be to stick to the simple option and focus on
concentration development. If you are skilled in group working techniques
then you will probably already have a social skills programme that you have
used in the past. You may even have used the pack at www.educational-
psychologist.co.uk/social.htm as the basis for your programme. If so just go
ahead and build a programme with a mix of social skills games and
concentration games.

If you are new to group work the following is offered in a highly

prescriptive fashion to support you totally. If you work in school as a
teacher or support assistant then you have incredibly highly refined skills
with respect to dealing with children. After a while and when you are ready
let yourself go. Think up your own games. Develop your own style. Just as
teachers and parents each have their own style, then so do group leaders.

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 The Group Sessions

Session 1
1. Introductions
2. Why we are here
3. Coloring activity
4. Praise and good-bye

Session 2
1. Check in
2. Coloring activity
3. Activity swapping 2 activities
4. Praise and goodbye

Session 3
1. Check in
2. Coloring activity
3. Activity swapping 2/3 activities
4. Praise and good bye

Session 4
1. Check in
2. Coloring activity
3. Activity swapping 3 activities
4. Praise and good bye

Session 5
1. Check in
2. Copying/copying activity
3. Activity swapping 3/4 activities
4. Praise and good bye

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Session 6
1. Check in
2. Copying activity
3. Activity swapping 4 activities plus one really fun activity remote
control car?
4. Praise and good bye

Session 7
1. Check in
2. Class work activity
3. Activity swapping 4/5 with one really fun activity
4. Praise and good bye

Session 8
1. Check in
2. Class work activity leader out of sight
3. Activity swooping 5 with one really fun activity
4. Praise and good bye

Session 9
1. Check in
2. Class work activity leader out of sight
3. Activity swapping 6 with one really fun activity
4. Praise and good bye

Session 10
1. Check in
2. I remember when
3. Fun activities
4. Praise and good bye

Maintenance Sessions (periodic e.g. 6, 12 24 weeks)

1. Check in
2. Fun activities
3. Praise and good bye

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 How to run the games
Introductions:
1. Introduce yourself with an additional and perhaps amusing addition to
your name. For instance, "I am Tiger Tim" or "Mrs. Fluffy Fox".
2. Ask the children in turn to do the same.
3.Tell the children that they will be asked to name one of the other children
in the group by their new name, but don't tell them which one

Why we are here

Explain that the children may not have learned to concentrate quite as well
as they could have done.

Explain that:
You have to learn lots of difficult things as you grow up. Learning to walk
and talk for instance.

Concentration and sitting still to do your work is a very difficult thing to

learn and this programme is there to help them with the thing that they have
found difficult

You may like to give an example of something that you have found difficult
to learn that may surprise them, your left from your right for example

Tell the children that the concentrating behaviors are:

• Sitting with your bottom on your chair.
• Head bowed and looking at your book or paper.
• Pencil moving

You will use this over and over, by asking the children to show you the
concentration behaviors. The class teacher can then use the same strategy in
the classroom to great effect. You may want to use verbal and non-verbal
cues to activate the desired behavior, such as

• Show me your concentration skills

• A hand signal
• An audible signal such as a rattle.

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Check in:
This is a simple but essential component of any group that seeks to be
supportive. Each member of the group takes their turn to report on their
week. Instigate this by asking an age appropriate question such as, "Has
anybody got any news" or "How have things been". If you are running a
social skills component in your course this is when you will gather much of
your material for use that day. For instance a child may have found itself in
a complex situation. The group will help problem solve and find a better
way of managing the situation. If your focus is solely concentration you will
not want to get distracted by outside issues such as, “I had a fight with
Jimmy” matters that need to be addressed such, “Dad killed my dog”, will
need to addressed outside the group. It is crucial that you tell the child that
you will speak to them afterwards. The level of trust the children will
develop in you as group leader is very high and they may take a chance with
you and tell you things they wouldn’t tell their teacher. This is not a
reflection on their teacher more a reflection of the slightly different
relationship of a group leader to the children. Make absolutely sure that you
know what the school/education authority policy and procedures are with
respect to disclosure if you are going to see children individually.

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Coloring Activity
The children need to be seated around a table. Give them a page with some
very small circles on, they will be expected to color them in (See appendix 1
for an example). Tell the children that you want them to do the task for ten
seconds at first but you will be building this up over time. At the end of the
set period give the children a break for thirty seconds or so. Encourage them
to have a wiggle and to shake out the tension. The expected behaviors when
on task are: Bottom on seat, head bowed, pencil in hand, pencil moving.
The pattern will look like this;

10 seconds coloring
30 seconds shake out the tension/ look out of the window/talk etc.
10 seconds coloring
30 seconds shake out the tension/ look out of the window/talk etc
10 seconds coloring
30 seconds shake out the tension/ look out of the window/talk etc.
10 seconds coloring
30 seconds shake out the tension/ look out of the window/talk etc
and so on until you feel that you can extend the time on task.

As the children are working gently praise and encourage. As the session/s
move on go onto larger circles (See appendix 2 for an example) and then to
conventional pre drawn pictures. There is a difference between time on task
with praise and encouragement and time on task without. Be very aware of
this and be lavish with praise when you ratchet up the time on task. The
point at which you should ratchet up the on time task is when the children
can stay on task without praise and encouragement.

Once the children can stay on task for a couple of minutes move onto the
children doing their own drawing and coloring it.

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Copying Activity
Once the children have become accomplished at coloring and drawing for
ten minutes move them onto copying. Do this in the same way that you did
with coloring. I know that copying is bad practice but it takes less cognitive
resources than free writing thus leavening these children more resources to
keep themselves on task. To extend this move onto free writing.

Once the children have got up to a ten-minute period of on task behavior,

take out a bunch of keys and rattle them as you walk around the group.
Praise them for staying on task. If they look up make a joke of it along the
lines of, “Got you!”

When they children have got accustomed to working with the keys, find
other ways to try and distract them. “Would you like a piece of chocolate”
is a good one.

Once they have got this far I usually leave the room and stand outside the
door just outside the children’s vision. The time to re enter is when you
sense they are becoming restless. They usually move before they talk which
you will hear.

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Class work activity
This is simply the final stages of the programme. The children are given
class work to do in the group. They must be able to do this work without
assistance.

Activity Swapping
This game involves having a range of tabletop activities for the children to
engage with. All arranged around one table. As you will gather from the
session outlines as time goes on the number of activities increases. Start
with two activities one slightly more attractive than the other. For instance a
jig saw puzzle and a sand tray. Increase this to include activities such as
copying, free writing, coloring, handwriting, Lego and something really
exciting such as a remote control car.

The idea here is that the children rotate activities. Thus they may be writing
whist someone else is playing with the car. Again you expect the on task
behaviors for pencil and paper tasks that are listed above. These need to be
stressed to the children. Clearly you need to ensure that all the children get a
go of the nice activity but the bulk of the time is spent on pencil and paper
activities where they have to display the on task behaviors.

Praise and Goodbye

The very act of making an important issue of concentrating should have an
effect. Praise the children regularly as a group and as individuals by
mentioning that they have concentrated well, that they are becoming a super
sitters, etc.

I Remember When
The children absolutely love this game. It is rather like a parent telling their
own children about the funny things that the children did when they were
little. I usually say something like, “Mickey do you remember when I
observed you in class and you were hiding under the table?” This is said
with much mirth and fondness. This is not to say that one is condoning the
behavior what you are saying is that the behavior is so far in the past that a
repetition is unthinkable now and so it is OK to laugh about it. This in itself
reinforces the extinguishing of the behavior, because they would really let
you down if it ever reappeared.

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Fun activities
This are the sort of fun games children might play at a party. If you wanted
to make a real fuss of the children and had the time to prepare you might
play pass the parcel etc. If you are a bit more formal in your style you might
let the children play board games. The idea is to leave the children with
fond memories of the group but to make the point that this is an end time
and things are different now, because they have done the course, which is
over.

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